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HOSPITAL CONSTRUCTION, 
 
 BY 
 
 EDWARD HUTCHINSON, M. D. 
 
To the State Board of Charities: 
 
 Gentlemen — The subject of hospital construction has engaged 
 the attention of philanthropists for years, but never, perhaps, with 
 more earnestness than at the present time. The statistics of the 
 old time hospitals of the larger cities on the continent have given 
 such alarming death rates from diseases not frequently met with in 
 private practice, that every exertion has been made to ascertain 
 what have been the causes of the mortality. 
 
 No one has done more to show the evil results of over-crowding 
 as affecting the surgical cases, and to call attention to the saving of 
 life which could and should be made by those having under their 
 control the construction of establishments for the sick, than Sir 
 James Y. Simpson, of noble memory. Miss Florence Nightingale 
 has spent her life investigating the causes of the excessive mortality 
 in great hospitals, and has written most ably in behalf of enlight¬ 
 ened management in the conduct of these institutions. Sanita¬ 
 rians everywhere have made a study of the means best adapted to 
 insure the welfare of invalids, and to give them the best chances for 
 recovery. All are agreed that solid hospitals of two, three and 
 four stories, with their layers of sick, are bad, and some have even 
 questioned whether it would not be better to keep invalids at home 
 even with all the inconvenience and hardship to result from such a 
 course, than to invite death by exposing them to the dangers of 
 hospitalism. 
 
 Under the wise administration of the Army Medical Bureau 
 during our late war, the fact was soon ascertained that both sick and 
 wounded men recovered sooner in tents, and with less average mor¬ 
 tality, than in old-fashioned hospitals. When it became necessary 
 to construct large permanent hospitals in the rear, the tent or 
 pavilion plan was the one adopted. This showed great wisdom, 
 and the saving of life in consequence was immense. The Germans 
 were quick to take advantage of the experience we had to offer, and 
 built pavilion hospitals for the wounded of both sides, in the war of 
 1866, and also in the late war of 1871. By having the wounded 
 and sick in open tents or light wrnoden structures, located in airy 
 positions w T ith plenty of sunshine and ventilation, the results were 
 surprising. Erysipelas and pyaemia with hospital gangrene became 
 rare, and when these dreadful diseases did break out, the infection 
 was less apt to spread. In the southern states too, the confederates 
 
256 
 
 Annual Report of the 
 
 did not fail to see the advantages of this method, and in Atlanta,. 
 Ga., and Raleigh, 1ST. C., their admirable pavilions were models of 
 neatness and convenience. In Dresden, Leipzig, Ghent and Berlin 
 there are fine one storied pavilion hospitals; but in this country, so 
 far as I am aware, there has been no considerable attempt to make 
 them permanent. 
 
 The objects of a good hospital maybe briefly described: — To 
 care for the sick better than they can be provided for in their own 
 homes: to cure sick people at the least expense: to have a conven¬ 
 ient administration so that a few physicians and nurses can do the 
 Aork: to give those suffering from surgical operations the best 
 chances for recovery with life and limb : to care for the poor who 
 cannot afford the things necessary for their own comfort: that child¬ 
 bed cases may be kept secluded and not exposed to dangerous influ¬ 
 ences by contagion, whether by physician, nurses or location: to 
 have provision for the contagious diseases of childhood as well as for 
 those of adult life, so that the mortality may not be increased by the 
 aggregation of the sick. 
 
 In regard to the general construction of a hospital, the following 
 points may help to guide us. 
 
 Arrange the wards so that no sick person will endanger the life 
 of another. 
 
 Have a plentiful supply of pure air, with provision for the escape 
 of the foul air. 
 
 Supply at least 1,200 cubic feet of air to each bed. 
 
 Separate the sexes, and also medical, surgical and child-bed cases. 
 
 Make provision for isolating contagious diseases. 
 
 Have a bountiful supply of pure water. 
 
 Have all the drains go entirely outside of the buildings. 
 
 The wards should be so arranged, that they may have the greatest 
 possible exposure to the sun. 
 
 Separate the convalescents from those confined to bed — during 
 the day at least. 
 
 Have the wards on one floor, and but one story high. 
 
 Delirium tremens, accident and insane patients should have apart¬ 
 ments at such a distance from the wards that they may not disturb 
 the rest of the sick. 
 
 There should be small wards to isolate troublesome patients, and 
 for those who are easily disturbed. 
 
 The kitchen and laundry should be separate from the wards, so 
 that the odors of washing and cooking cannot reach the sick. 
 
State Board of Charities. 
 
 257 
 
 Water-closets and slop-sinks should be away from the wards, 
 and have separate ventilation. 
 
 The nurses’ room should overlook the ward. 
 
 There should also be a high and airy situation ; a cheerful view ; 
 in-door promenades; extensive ground for exercise ; flower gardens 
 and lawn. 
 
 Have no cellars under the wards. 
 
 Have hard, unabsorbing surfaces for walls and ceilings. 
 
 Let the floors be oiled or painted, so that they will not absorb 
 water. 
 
 The wards should be so far distant from each other that the air 
 may circulate freely. 
 
 The corridors connecting the wards to be open beneath, and pro¬ 
 vided with glass windows to slide open, to allow the air to blow 
 under and through them. 
 
 Have fire-places in the wards to assist ventilation, and to supple¬ 
 ment the heating apparatus. 
 
 Have two steam boilers for fear of accident. 
 
 The administration building ought to be distinct from, yet attached 
 to, the wards. 
 
 The heating, washing, drying and cooking should be done by 
 steam. 
 
 Have such an arrangement of the wards that any one of them can 
 be disinfected, or even torn down, without disturbing the general 
 administration. 
 
 The trustees of St. Elizabeth’s Hospital, Utica, in order to accom¬ 
 modate the increasing number of patients who apply for admission, 
 have had under consideration, for a long time, plans for a new 
 hospital. These are now submitted for your suggestions, with the 
 hope that whatever is good in them may be of service to others, and 
 that you will point out any defects or omissions, in order that they 
 may be corrected. The architect, Mr. Wm. H. Hamilton, of Utica, 
 is deserving of the highest praise for his intelligent aid and valuable 
 labors. To him the trustees desire to express their thanks, and 
 also to acknowledge their obligation to Dr. John P. Gray, of the 
 State Lunatic Asylum, for having interested himself from the first 
 in perfecting the present plan of construction, and for his many 
 suggestions and final approval. 
 
 The hospital will be built on the pavilion plan, on high ground, 
 situated in the eastern part of the city. Its general appearance is 
 shown by the engraving at the beginning of this article. The cen¬ 
 tral building is designed to contain the rooms for general adminis- 
 33 
 
258 
 
 Annual Report of the 
 
 tration, dispensary, parlors, office, library, operating-room, and 
 apartments for the religions order which has control of the institu¬ 
 tion. In the basement will be the porter’s room, and the small 
 wards for delirium tremens and insane patients, and accident cases. 
 
 The pavilions are arranged on each side of the main building, as 
 shown in the second engraving, and radiate from the circumference 
 of a circle, in such a manner that the end wards will be on a line 
 with the principal structure. 
 
 They will be at least thirty feet apart in front, where they are 
 nearest together, and sixty feet apart in the rear. This will allow 
 of a free circulation of air, will not obstruct the light, and will be 
 sufficient to prevent the spreading of contagious diseases if any 
 should, by accident, be received. They will be connected with each 
 other and with the administration building by glass corridors twelve 
 feet wide and ten feet high. These are entirely open "beneath, and 
 have flat roofs which are guarded, front and rear, by railings to pro¬ 
 tect those who wish to sit in the open air. The fronts of the 
 pavilions have large bay windows in order that the convalescents 
 may enjoy the lovely view of the Deerfield hills ahd Mohawk val¬ 
 ley. The front of each pavilion will be two stories high and may 
 be called the administration end. This will contain, on the first 
 floor, the extra diet kitchen, dining room for convalescents, the 
 linen room, the trunk room for patients’ clothing, a nurses’ room 
 overlooking the ward, and bath rooms and water closets. In front 
 is a large hall for exercise and recreation. Up stairs, are rooms for 
 reading, sewing and amusement. It is intended that patients who 
 are able to leave the wards during the day shall pass most of their 
 time here, and not in the wards. The third engraving will give an 
 accurate idea of the first floor of a ward pavilion. 
 
 Back of the administration end is the ward proper. This is one 
 story high and intended to contain 20 beds. It is 80 feet long, 26 
 feet wide and 16 feet high, giving 33,280 cubic feet in all, or 1,661 
 cubic feet of air for each patient, and 101 square feet for each bed. 
 The southern end of the ward will be inclosed with glass, like a 
 conservatory, so that the sick may have the benefit of sun baths, 
 and it may, if desirable, be ornamented with flowers. 
 
 The windows reach from floor to ceiling, and are so arranged as 
 to have two beds between them. The sunlight will be admitted 
 freely. 
 
 The floors will be made of narrow hard w r ood boards, driven 
 together and made water tight. The w r alls and ceilings will be hard 
 finished and painted with a silicate of soda composition, so that they 
 
State Board of Charities. 
 
 259 
 
 may be washed. This will allow the whole surface to he easily 
 cleaned. 
 
 It will be observed that the projecting portion of the pavilion 
 inclosing the water closets has a separate tower reaching above the 
 roof, for ventilation. This tower can be removed still further from 
 the hall and made external to the outer wall, but wherever it is, it 
 will be difficult to prevent the odors from escaping into the build¬ 
 ing. A constant flow of water and daily washing are the best 
 means to keep this department in good sanitary condition. 
 
 The pavilions will be constructed of wood with double walls, and 
 the roofs will be covered with slate. The basement walls will be 
 arched in such a manner that while the air will not be confined 
 underneath in warm weather, they may be boarded up, if neces¬ 
 sary, in winter. 
 
 It will be noticed that if it ever should be desirable, any pavilion 
 can be torn down and rebuilt without interfering with the useful¬ 
 ness of the hospital, and any one could be disinfected, or remain 
 unoccupied any length of time, without the slightest inconvenience. 
 
 Tlie buildings at each end are two stories high and divided into 
 double rooms. These are intended for private patients, or for 
 those who require seclusion, such as eye cases, etc. 
 
 There is a promenade through the front halls of the pavilions 
 and the corridors, nearly 200 feet long, on each side of the center 
 building. On the main floor this is under cover, and above, on top 
 of the corridors, the patients may sit in the open air in pleasant 
 weather. 
 
 The kitchen, laundry, engine and coal rooms, with the servants’ 
 quarters, will be in a pavilion in the rear of the main building. 
 The odor of the cooking and washing cannot reach the sick. 
 
 The drains will all be outside of, and not run underneath, any of 
 the buildings. 
 
 The engine-room, in the rear, will contain the steam-boilers, and 
 from them the pipes will lead right and left to the pavilions through 
 the corridors. In the center there will be two stacks, or coils, which 
 will warm the fresh air as it comes through the air-boxes from out¬ 
 side, as shown in the fourth engraving. These air-boxes are placed 
 under the floors, and open on each side of the ward. Valves will 
 be so arranged that the supply may be regulated at pleasure. This 
 will be supplemented by suitably arranged pipes or coils so placed 
 as to give direct radiation. The heating will thus be by indirect or 
 direct radiation, either one or both, according to the severity of the 
 weather. The stacks of steam-pipes in the center of each ward will 
 
260 
 
 Annual Report of the 
 
 be so large, that except in the coldest weather, they will be expected 
 to heat enough fresh air to keep a large and constant supply con¬ 
 tinually in circulation. 
 
 The method of ventilation may be understood by referring to the 
 fourth engraving. The fresh air will enter through the floors of 
 the wards from the air-boxes beneath, and after being heated by the 
 large coils will ascend to the ceiling. The ventilating flues, shown 
 at each side of the w^ard, are to be of glazed tile, and they will rise 
 from floor to ceiling near the walls, but not be in contact with them- 
 The foul air will enter at the floor and pass through the warmed 
 tile-pipes to the attic, and thence out through the escape-flues in the 
 roof. These outside ventilators will be of the same height in all the 
 pavilions, so there can be no downward currents. There will be 
 ten columns in each ward, one between every two beds. 
 
 In the present hospital, this system of fresli-air supply, steam coil 
 heaters, inside warm, ventilating-flues, with openings at the floor, 
 and ridge escape-ventilators in the roof, is in full and perfect opera¬ 
 tion. Practically, the air is constantly changing in every ward, foul 
 and hospital odors cannot be detected, and the atmosphere is far 
 purer than in most private residences. 
 
 Provision is made for summer ventilation, in the new hospital, 
 by opening large circular ventilators in each ceiling, and, with open 
 wundows, there will be a constant change of air. 
 
 Double tire places will be provided in case any temporary accident 
 should befall the steam apparatus. 
 
 Speaking-tubes will connect each department with the central 
 office. 
 
 The water supply will be independent. 
 
 The lying-in ward will have a portion set aside by partition, as 
 shown in the third engraving, hfo. 6, for a delivery w r ard. Should 
 child-bed fever occur, the other patients could be easily moved into 
 another pavilion. 
 
 Children attacked with contagious diseases may be best cared 
 for in some of the upper rooms, away from the lying-in ward. 
 
 A small cottage will be built in one corner of the grounds for any 
 contagious disease requiring complete isolation. 
 
 Thorough cleanliness, abundance of sunlight and fresh air, and, 
 if necessary, isolation, will render it difficult for any disease to 
 spread from one patient to another. 
 
 The whole hospital will face toward the north, where the view is 
 exceedingly beautiful. The rear wards spread toward the south, 
 and thus will be exposed to the sun all the day long. 
 
State Boajrd of Charities. 
 
 261 
 
 Wire or gauze screens will be placed inside of the windows so 
 that while patients may look out, they cannot see the sick in the 
 neighboring wards- 
 
 The vegetables will be kept in the outbuildings and not under the 
 wards. 
 
 The dead house and burial chapel will be in the rear. 
 
 The great chimney will have an iron smoke pipe in its center 
 reaching to the top. Around this pipe a column of warm air will 
 be constantly ascending, and into this space will be conveyed the 
 ventilating flues from the wash house, soiled-linen room and kitchen. 
 
 To prevent the sewage gases from entering the buildings, there 
 will be a small ventilation pipe from each drain outside the walls, 
 reaching up above the roofs. This will give an outlet for the back¬ 
 ward currents of sewer gas, so that the water valves in the traps 
 may be effectual. 
 
 One objection that might be suggested to the pavilion hospital 
 just described, is that it occupies too much ground. To this it may 
 be replied that it is far better for the sick to be away from the cen¬ 
 ter of a town ; and on th6 outskirts of most cities, land may be easily 
 secured without great expense. 
 
 Whether the pavilions are far enough apart might be a question ; 
 however, by this arrangement, the sick will be separated from forty 
 to sixty feet across the open spaces, and between the nearest beds 
 at least ninety feet w r ill intervene through the halls and corridor. 
 
 In Captain Galton’s model w T ard, in the great Herbert hospital 
 at Woolwich, and in many of the latest English hospitals, the 
 water closets and baths are at the free ends of the wards. This 
 arrangement has its advantages, but it cuts off' the sunlight. In 
 the plan under consideration, the ends of the wards project to the 
 south and are inclosed with glass. The closets are toward the 
 corridors but have distinct ventilation and are besides cut off from 
 direct communication with the sick as completely as in the English 
 method. 
 
 It has been strongly urged by Florence Nightingale that there 
 should be no rooms for convalescent patients to sit in during the 
 day, as they are apt to become unruly. To this it may be urged, that 
 it is better to keep invalids in the hospital and under treatment, than 
 to allow them to be exposed too soon. It is true that the sick are 
 cheered by the sight of the convalescent, but it is also true that the 
 very sick are greatly annoyed by the ordinary occupations of those 
 who are nearly well. However, there is space enough for either 
 method. 
 
262 Annual Report of the State Board of Charities. 
 
 It may be said that it will be impossible to beat such an exten¬ 
 sive series of buildings by steam in such a cold climate as we have 
 in this section of the State. All experience in our State lunatic 
 asylum and cotton and woolen mills goes to the contrary, and with 
 double windows it is proved not only possible but easy. 
 
 The frontage will be 550 feet, and the depth 225 feet. 
 
 The cottage pavilions at each end will contain 52 beds, and the 
 four open wards 80 beds, making a total of 132 beds. To these 
 may be added 21 more, which could be used in case of need, in the 
 upper rooms in the front of each pavilion, making a total of 156 
 beds. This is exclusive of those in the rooms in the main build¬ 
 ing, and in the servants’ quarters in the rear. 
 
 The architect’s estimate of the cost of the whole structure, includ¬ 
 ing steam apparatus, is $75,000, or less than $500 per bed. This is 
 on the supposition that the central building be of brick and the 
 pavilions of wood. Whether these estimates are correct can only 
 be ascertained after the hospital shall have been completed, and 
 unfortunately, the trustees have not yet been able to secure the 
 necessary funds-—-which, however, they hope to accomplish. 
 
 Trusting that this brief contribution to the subject of hospital 
 construction may meet with your approval, and thus lead to the 
 building of institutions on this or some similar plan; I renjain 
 with great respect, 
 
 Your obedient servant, 
 
 EDWIY HUTCHmSOtf, M. D. 
 
 Surg&bn-in-charge , St. Elizabeth?s Hospital. 
 Utica, N. Y., January 1, 1875. 
 

 
 
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